Özden Hatice Ömercikoğlu, Çelik Nazlı Durmaz, Bayraklı Fatih, Özkan Serhat, Vural Murat, Öner Özge Gönül, Günal Dilek İnce
Department of Neurology, School of Medicine, Marmara University, Basibuyuk Mah. Maltepe Başıbüyük Yolu Sok. No:9/2 Maltepe, 34854 İstanbul, Turkey.
Department of Neurology, School of Medicine, Eskişehir Osmangazi University, 26040 Eskişehir, Turkey.
J Clin Med. 2025 Jul 30;14(15):5382. doi: 10.3390/jcm14155382.
: Dystonic cerebral palsy (DCP) is a complex, disabling manifestation of secondary dystonia, which significantly impacts motor function, quality of life, and well-being. Conventional pharmacologic therapies frequently do not relieve symptoms sufficiently. Deep brain stimulation (DBS) of the globus pallidus internal segment (GPi) has gained increasing attention as a neuromodulatory therapy for refractory dystonia. Still, the experience of the effect of GPi DBS treatment in adults with DCP has, until recently, been limited. : We performed a retrospective, two-center case series of 11 adult patients with medically refractory DCP who underwent bilateral GPi-DBS. The clinical outcomes were evaluated based on the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), the Functional Independence Measure (FIM), the Gross Motor Function Classification System (GMFCS), and the Caregiver Burden Scale (CBS). The assessments were done preoperatively and at 1-year follow-up. Changes in continuous variables were analyzed using paired -tests. : At the 1-year follow-up, the mean BFMDRS score improved from 69.6 ± 27.6 to 54.3 ± 36.5 ( = 0.001), indicating a significant reduction in overall dystonia severity. Functional independence also improved, demonstrated by the rise in FIM scores from 65.3 ± 33.9 to 79.2 ± 43.4 ( = 0.006). Although GMFCS levels did not change in most patients ( = 0.125), the burden on caregivers decreased significantly, with CBS scores falling from 35.7 ± 18.8 to 32.0 ± 17.1 ( = 0.015). There were no surgical complications. : In adults, bilateral GPi-DBS is a safe and effective intervention for DCP, improving motor control and increasing functional independence while decreasing caregiver burden. These findings lend support to its role in the multidisciplinary management of DCP.
肌张力障碍型脑瘫（DCP）是继发性肌张力障碍的一种复杂且致残的表现形式，它对运动功能、生活质量和幸福感有显著影响。传统药物疗法常常无法充分缓解症状。苍白球内侧部（GPi）的深部脑刺激（DBS）作为一种治疗难治性肌张力障碍的神经调节疗法，受到了越来越多的关注。然而，直到最近，GPi DBS治疗成年DCP患者的疗效经验仍然有限。
我们进行了一项回顾性、双中心病例系列研究，纳入了11例药物难治性DCP成年患者，他们接受了双侧GPi-DBS治疗。基于伯克-法恩-马斯登肌张力障碍评定量表（BFMDRS）、功能独立性测量（FIM）、粗大运动功能分类系统（GMFCS）和照顾者负担量表（CBS）对临床结局进行评估。评估在术前和术后1年进行。使用配对t检验分析连续变量的变化。
在1年随访时，平均BFMDRS评分从69.6±27.6改善至54.3±36.5（P = 0.001），表明整体肌张力障碍严重程度显著降低。功能独立性也有所改善，FIM评分从65.3±33.9升至79.2±43.4（P = 0.006）。尽管大多数患者的GMFCS水平没有变化（P = 0.125），但照顾者的负担显著减轻，CBS评分从35.7±18.8降至32.0±17.1（P = 0.015）。没有手术并发症。
对于成年DCP患者，双侧GPi-DBS是一种安全有效的干预措施，可改善运动控制、提高功能独立性并减轻照顾者负担。这些发现支持了其在DCP多学科管理中的作用。
